Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 5414484-1205 | UT |
NPI | 1033272489 |
---|---|
Provider Name | Kelly Lynn Konopa |
First Address | Salt Lake City, UT 84102-4172 |
Second Address | Salt Lake City, UT 84112-5550 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/12/2006 |
Last Update Date | 20/12/2010 |